Visual disturbances and pathologic ocular findings in primary antiphospholipid syndrome

To delineate the features and prevalence of the systemic and ophthalmic involvement of primary antiphospholipid syndrome (PAS).

Prospective case series.

A total of 39 consecutive patients with PAS.

During an 18-month period, the medical records of all patients with PAS who attended a clinic for thrombosis and hemostasis were reviewed on arrival. The patients were then referred to a retinal clinic and examined prospectively. The first 20 consecutive patients underwent retinal fluoroangiography.

The prevalence of the various organs affected by the disease was noted in the group, as well as the prevalence and type of ophthalmic involvement.

The most common forms of systemic involvement were fetal loss in 11 female patients (46%), central nervous system involvement in 17 patients (44%), and venous thrombosis in 16 patients (41%). Ophthalmic findings were as follows: 13 patients (33%) were symptomatic, and 12 of them complained of visual disturbances. In 10 (83%) of these 12 patients, the visual symptoms were transient, and 7 of them were nonocular in nature. Pathologic signs on ophthalmic examination were found in 5 of the 39 patients (13%), two of whom had intraocular pathologic findings related to PAS, and these were in the form of mild retinopathy. Of the 36 patients who were either asymptomatic or had transient visual disturbances, pathologic ocular findings were detected in only 2 (6%). Routine retinal fluoroangiography did not reveal any additional information that could not otherwise have been detected by funduscopy.

Ocular involvement in PAS is uncommon. Transient visual disturbances are common, although most of them are related to central nervous system rather than ocular ischemia. Pathologic ophthalmic findings are unlikely to be found in asymptomatic patients or in patients with transient visual disturbances. Routine retinal fluoroangiography performed on patients with PAS is unproductive.